The femoral stem pump in cemented hip arthroplasty: An in vitro model

The presence of an intra-articular pump has been proposed as a central mechanism in the process of osteolysis and aseptic loosening of hip arthroplasty. It is not known if this pump exists and its mechanism remains uncharacterised. tudy describes a new in vitro model of a cemented femoral stem in which cement/stem interface fluid pressures can be reliably measured under dynamic loads simulating stair climbing. A stem pump mechanism was found that generates both positive and negative clinically significant pressures (mean pressure ranges 5000–17,000 Pa). The timing of pressure peaks on the anterior and posterior aspects of the stem were in anti-phase, giving rise to oscillatory pressure gradients and potentially generating oscillatory fluid flows during the simulated physiological load cycle. The pump mechanism was shown to occur at the interface of a newly implanted polished double-tapered stem and emphasizes the importance of a complete mantle to protect the femoral bone from the raised fluid pressures.